Provider Demographics
NPI:1639690365
Name:FOOD MERCHANTS, LLC
Entity Type:Organization
Organization Name:FOOD MERCHANTS, LLC
Other - Org Name:ALPS LONG TERM CARE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAVLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-818-3125
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-0397
Mailing Address - Country:US
Mailing Address - Phone:417-818-3125
Mailing Address - Fax:417-374-7582
Practice Address - Street 1:1824 N HWY CC STE A
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8015
Practice Address - Country:US
Practice Address - Phone:417-893-3902
Practice Address - Fax:855-547-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MO20170184383336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171118OtherPK
MO600047083Medicaid